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This Dr. Amy Tuteur woman drives me crazy.  

post #1 of 168
Thread Starter 

I stumbled upon her latest article:

 

EDITED TO ADD: I just realized where I am posting this and if you are actively planning a homebirth, you might not want to read it.  It is designed to fear women who want a homebirth.  Just a friendly warning.

 

www. skepticalob. com/2014/01/homebirth-midwives-reveal-death-rate-450-higher-than-hospital-birth-announce-that-it-shows-homebirth-is-safe.html

 

I don't even know where to begin.  She twists things so much it's hard to tell what's what anymore.  I am going to show this to my math whiz of an s.o. and see if he finds it to be as confusing and misleading as I do.

 

On the other hand, I thought you all would be interested to know that in freshman year of college, I wrote a paper that was a rebuttal to her slamming homebirth and I got an A on it :)

 

Edited to break link

post #2 of 168
Dr Amy is so annoying. I really don't understand how any woman with even a little self love and intelligence could argue so passionately and unrelentingly to limit women's choices.

I didn't actually read the article you posted as I'm 36w2d and don't want to get all worked up over her nonsense but I have read her stuff before and think she's evil.

Great job on the A!
post #3 of 168
There is much to hate about Dr Amy, but she does not want to limit women's choices. She believes HB is riskier and she wants women to have accurate information before they choose:

www skepticalob com/2014/01/homebirth-hater-no-but-heres-what-i-do-hate.html

edited to break link
post #4 of 168
Um, no, to the above. Dr. Amy is disgustingly hateful toward women who choose homebirth. She has a long, lovely track record.

I would love to hear what your SO says, bunny627. I read the research itself, but I'm no statistician. It looked like the fetal and neonatal deaths were mainly cord accidents or shoulder dystocia. Also they mentioned not knowing the status of congenital anomalies due to lack of autopsy in most cases.
post #5 of 168

She used to have a blog called Treat Me With Respect, about neglect of patient rights in hospitals.  Somehow she's never applied that to pregnant women.  According to her, any bad outcomes in homebirths are entirely the fault of homebirthers and midwives, and not our messed-up institutional maternity care system.

 

450% of a low risk is still a reasonably low risk.  She used to compare homebirths against all low-risk hospital births, now she is comparing only against low-risk white women, which skews the numbers more in her favor.  Most of the homebirth population is indeed white, but there is a large proportion that would not medically be considered low risk (because of VBAC, age, number of previous pregnancies, GD, obesity, etc.)   No one has ever really matched the two populations to do an apples-to-apples comparison of the relative safety of birth settings in the U.S.

 

No one talks about how hospital birth is very strongly correlated with having a small family.  I haven't looked at the parity data yet, but I bet it is significantly higher in the homebirth population.

 

I also noticed that many births were macrosomic (about 25% of babies were above 4000 g), yet the outcomes were generally good.  Hospitals tend to over-intervene for larger babies.  Also, there was a high breastfeeding rate (87% at six weeks), which probably means fewer neonatal deaths and fewer cases of breast cancer later on.  Hospital births are strongly correlated with breastfeeding "failure".  If we're going to talk about risks, let's talk about ALL the risks, not just neonatal death.

post #6 of 168
"According to her, any bad outcomes in homebirths are entirely the fault of homebirthers and midwives, and not our messed-up institutional maternity care system."

Yeah this is part of her thought process that I don't understand. Maternal mortality in hospitals is way up compared to 15 years ago, there are rampant reports of women being abused and assaulted in hospitals, I think even infant mortality in hospital birth has climbed significantly, yet she somehow disregards all of this! Where's the logic in that?!
post #7 of 168
"She used to have a blog called Treat Me With Respect, about neglect of patient rights in hospitals. Somehow she's never applied that to pregnant women"

I didn't know about the old blog but it really pisses me off when people argue that everyone should have the right to bodily integrity and autonomy except pregnant women. Makes my blood boil!!
post #8 of 168
1. I’m not really interested in whether Tuteur is mean, rude, or annoying.  I’m interested in whether or not she’s right.  And as far as I can tell, she is.  
 
The MANA data revealed two numbers that are relevant to the discussion of hospital  vs. homebirth mortality rates (note that it doesn’t cover serious birth injuries, which is also a major concern in either setting):
 
1. The death rate for all homebirth babies was 2.06/1000.
2. The death rate when high risk pregnancies (here defined as breech births, VBACs, mothers with preeclampsia, and gestational diabetes) are excluded is 1.61/1000.
 
What she then does is compare these numbers for comparable populations in a hospital setting.  She uses full-term labors with white mothers.  Both provide a reasonable basis for comparison since (as far as I can tell) no one is advocating homebirth for premature births and the MANA stats show that over 92% of the women were white.
 
For full term white mothers, the hospital death rate is .38/1000 .  (That’s extremely low, by the way.  People often claim that “babies die in the hospital too!”  That’s true, but it’s incredibly rare for a full-term baby to die in the hospital.  Most of those who die are preterm, and would have been delivered in the hospital even if the mother had been planning a homebirth. Intrapartum deaths are virtually unheard of in a hospital setting.  The MANA study found a 1.30/1000 rate of intrapartum death).  She points out that 1.61 is several times higher than .38.
 
The other clearly relevant issue that was raised by this study concerns high-risk births, and breech births especially.
 
The MANA study included 222 breech homebirths.  Out of those 222, there were 5 deaths.  The death rate for breech births in the hospital is .8/1000.  For home births it was roughly 20/1000.  That’s approximately 25 times as high as the hospital rate.  That’s appalling.
 
I think that one can reasonably argue that the absolute risk for homebirth remains low, and is still a reasonable option for many women.  I don’t think that we can say any longer that home birth is a responsible option for high-risk births, and especially not for breeches.  It may be “a variation of normal,” but it’s a very dangerous variation.  
 
2. “450% of a low risk is still a reasonably low risk.”
 
True.  And it may be the case that a mother who is aware of this will still choose home birth.  However, if there is a substantially increased relative risk, then it’s unethical to tell mothers that home birth is as safe or safer than hospital birth for the infant.  It isn’t.
 
3. “Maternal mortality in hospitals is way up compared to 15 years ago…”
 
And yet the maternal mortality rate (for all pregnancies, not just low risk ones) is .21/1000.  That’s higher than other industrialized countries (in the UK, for example, it is .12/1000) and that’s a major cost for concern.  However, the risk of maternal mortality and the risk of neonatal mortality are not even in the same neighborhood.
 
4. “I think even infant mortality in hospital birth has climbed significantly”
 
Infant mortality measures deaths from birth to one year of age.  It is a far more accurate measure of pediatric care than of the safety of a given birth setting.  
post #9 of 168

Unlike appalled, who i strongly suspect works in the health care field, i am concerned about "fuzzier" notions like being mean, rude or annoying. It is not at all surprising to me that OB's disregard the importance of common decency and respect for patient rights in favour of "science", which changes daily but somehow always manages to buttress their power mongering positions.

post #10 of 168

In other words, i care might care more if someone's an asshat to me than if they're right. But i guess i'm just human, unlike these doctors who are all Gods.

post #11 of 168

Also, you are several times more likely to die in a car accident than on a bus. Maybe we should strongly argue that pregnant women shouldn't be able to ride in cars.

 

Similarly, you are several times more likely to die from being struck by lightening if you are outside as opposed to inside, maybe we should make it illegal for pregnant women to leave their homes in the rain.

 

You are also way more likely to die from a plane crash if you are on a plane, maybe pregnant women shouldn't be allowed to ride in planes.

 

Leaving the house itself exposes pregnant women to all kinds of possible hazards, maybe pregnant women should not be allowed to leave their homes in the name of fetal safety and fetal rights.

 

The end of logic train is no where in sight, only more and more reasons to limit women in their unborn babies. And do we really still believe that we are so different than cultures where these are normal practices, because even though we wish to do these things we don't actually carry them out...yet?

 

My body my choice, every time. Anyone who disagrees can go suck a rotten pear.

post #12 of 168
Quote:
Originally Posted by Viola P View Post
 

 

 

My body my choice, every time. Anyone who disagrees can go suck a rotten pear.

 

This is true. Your body, your choice. But why is it OK for women praising home birth to fling numbers around, but when it comes time to use those same numbers to show that there are increased dangers, suddenly women lose their minds and act like their choices are being taken away?

 

They aren't. There has been a surge in popularity of home birth lately, and as the numbers roll in, the picture has gotten clearer. In some states, bad outcomes have led to more restriction on care providers - just like in any health related field.

 

I realize that Dr. Teuter pushes buttons. She does it intentionally, because all of the voices pointing out the reality of the numbers nicely are simply ignored - her strident, sometimes cruel words get more attention. I came across her from MDC years ago when someone was all but screaming that she was evil. I expected to find a pile of lies, and instead I found that I had swallowed a fabricated presentation of the evidence that I had not been truly informed enough to see through (in science, it is not acceptable to just quote an abstract, or construct a sloppy study, or deliberately deceive your audience by asking the wrong questions. All of those things happen daily in the online natural birth community.) My posting history reflects this shift.

 

Anyhow...  I am still considering a home birth for my next and last child. I'm a healthy, low risk multipara with immediate access to tertiary care; I am in the population for whom this is not inappropriate. Folks would benefit from stepping back and recognizing that there has been quite a lot of claims made as to the supposed superior safety of homebirth, and of course there will be backlash against those that were exaggerated.

post #13 of 168

I have not once flung numbers around because to me the issue is always fundamentally about choice, not about statistics.

 

I am also very concerned that the increased limitations on women's choice is alienating women who might need care from getting it. Banning homebirth will only lead to an increase in the number of unassisted births, which is exaclty what's happening in the UK if i understand it correctly.

 

It is simply illogical and unreasonable to expect a person, or even an animal, to knowingly put itself in harm's way. For women who have been mistreated and abused at hospitals, anything will be better than going back to that, and this is a reasonable response that should be expected and accounted for.

 

If Dr. Amy truly wants what's best for babies she'd advocate for women to be treated with dignity and respect in hospitals, instead of banging her head against the wall demanding that women agree to be mistreated for the sake of their babies. She's definitely fighting a loosing battle.

post #14 of 168

Dr. Amy is not calling for banning homebirth.

post #15 of 168
"Also, you are several times more likely to die in a car accident than on a bus."

True. 

Now imagine that the auto industry started to air advertisements saying, "All studies show that cars are safer than buses!" That would be wrong. 

Oh, and by the way, I am most certainly not a healthcare professional. I would tell you what my job is but, quite frankly, it's none of your business. 

And I don't know how many times I have to say this, but I'll repeat it again: I have no interest in banning home birth. I respect your right to make any decision you want, no matter how foolish I think it might be. 
post #16 of 168

The issue is not about banning homebirth.  It's about allowing women to be fully and accurately informed of the risks that birth presents--in all settings--and then allowing those women to make the decision they feel is appropriate.  No one can make a truly informed decision if the information they receive is falsified, misconstrued, or prejudiced.

post #17 of 168
The example with the auto industry would be more accurate if there was a hateful blog that shamed women who drove cars using statistics on the increaed safety of buses to suppor them.

Dr Amy is like the person who holds up placards with pictures of dead babies and information about fetal development to try to dissuade women from having abortions but stops short of actually calling for a ban probably in order to not entirely alienate her audience.

I find it really ironic that we're essentially arguing over whether shaming and fear mongering are appropriate ways to further ones goals in the childbirth context.

Also, Dr Amy does not appear to support homebirth in any context, even in a situation where the only hospital nearby has terrible mortality rates and c-sections rates that are through the roof. This leads me to suspect that she has other motives.
post #18 of 168
Also want to add that I do think its more dogmatic than scientific since there is no acknowledgement of differences in safety from one hositpal to the next and a complete refusal to even consider that home birth might actually be safer in some circumstances. In contrast, I have never heard of a woman who supports home birth and women's choices ever argue that there is no circumstance where a hospital birth would be safer.
post #19 of 168
Quote:
Originally Posted by chickabiddy View Post
 

Dr. Amy is not calling for banning homebirth.

 

No, but she does essentially call for banning CPMs, which given the lack of CNMs and CMs doing home birth in most states, would effectively get rid of home birth options for mothers in many areas.

post #20 of 168

I'm not so interested in discussing Dr Amy as I am in discussing the article published by the MANAstats folks.

 

Has anyone read it? What did you think?

 

I was particularly alarmed by this: only ~52% of women in the study with EBL >500mL were treated with anti-hemorrhagic agents.

So, is this saying that some subset of MANAstats contributors don't treat PPH? There are many little details in this study that are ... concerning..... to say the least.

 

The breech mortality rate is alarming - as well as the fact as about 1/2 of the attempted breech home births were not vaginal births. Is this conveyed to clients attempting breech birth at home with a midwife? That there is increased risk of death, as well as a 50/50 chance of a c-section? Wouldn't/shouldn't this be included in proper informed consent?

 

We can bellyache about Dr Amy, or we can discuss the findings reported in this article. I'm all for informed consent - let's talk about what women deserve to know before they plan an OOH birth with a midwife.

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